The federal fraud trial began Tuesday for five former health care workers and two skilled nursing facilities in Allegheny and Beaver counties.
The sweeping August 2022 indictment alleges years of Medicaid and Medicare fraud, all in the name of increased profits with no extra work. Investigators with the state Attorney General’s Office said the schemes involved falsifying the number of hours worked at the facilities as well as patient records.
The indictment named two skilled nursing facilities: Brighton Rehabilitation and Wellness and Mt. Lebanon Rehabilitation and Wellness, both managed by Comprehensive Healthcare Management Services (CHMS).
The FBI raided both facilities in September 2020.
The individuals named in the grand jury indictment are Sam Halper, the CEO and a co-owner of both facilities; Eva Hamilton, Brighton’s former director of nursing from 2014 to 2020; Susan Gilbert, a Mt. Lebanon administrator from 2017 to 2020; Michelle Romeo, a CHMS manager from 2016 to 2022; and Johnna Haller, Brighton’s director of social services from 2015 to 2016 and a CHMS manager from 2016 to 2021.
The alleged fraud spanned several years, in some instances stretching back to just after CHMS bought the Brighton facility in 2014.
Between June 2018 and January 2020, Ms. Hamilton and Mr. Halper are accused of falsifying records in order to make it look like the facilities were meeting staffing and “direct care” requirements.
Pennsylvania requires 2.7 hours of direct care per day, per resident at such facilities. To meet that requirement, the two allegedly added hours worked by management and other administrators each day — despite the fact that they did not work directly with residents.
They’re also accused of including hours when nursing staff were on breaks and logging hours by employees who weren’t even in the building.
Investigators allege that scheme came after Mr. Halper “directed management staff at Brighton to keep staffing levels low to reduce costs.”
Investigators said Ms. Gilbert was embroiled in a similar scheme at the Mt. Lebanon facility, asking some staff to clock in for shifts they never worked, rewarding them for doing so with bonuses. She was indicted in February 2021.
The larger conspiracy allegedly stretched back to June 2014 and involved manipulating patients’ medical records to boost Medicare and Medicaid reimbursements.
The indictment alleged Mr. Halper, Ms. Romeo and Ms. Haller would tweak certain patient data points that they knew could draw larger reimbursements from the state. For example, they’re accused of changing data related to how much help a resident needed with daily activities like eating and moving.
The more assistance a resident needed, the higher they scored on that data point. The higher the data point, according to the indictment, the higher the reimbursement.
Another such data point related to depression, according to the indictment: a facility that had more patients listed as depressed helped boost government payments. Mr. Halper allegedly told one person to designate residents as depressed “without regard to whether the residents in fact suffered from depression.”
Beyond that, investigators said, Ms. Haller and Ms. Romeo would also put fake responses into residents’ questions to inflate their depression “scores.”
First Published: November 14, 2023, 10:37 p.m.
Updated: November 15, 2023, 10:46 a.m.
